Background: Fixed combinations of reserpine and a diuretic are not generall
y accepted as initial therapy of arterial hypertension. Reserpine has been
discouraged because of severe adverse events such as depression and peptic
ulcer.
Clinical Pharmacology: Reserpine leads to depletion of catecholamine stores
in central and peripheral neurons and thus reduces sympathicotonus. Given
as monotherapy reserpine has only weak antihypertensive properties. In comb
ination with a diuretic even low doses of the drug (0.05 to 0.125 mg daily)
lower blood pressure sufficiently.
Side Effects: Nasal constipation is the most frequently reported adverse ev
ent. Depression and peptic ulcer do not occur under low-dose reserpine-diur
etic combinations.
Vascular Morbidity and Mortality: Several epidemiologic trials demonstrate
that cardiovascular as well as cerebrovascular morbidity and mortality can
be reduced by reserpine-diuretic combinations.
Costs: Reserpine-diuretic combinations cost less than calcium antagonists,
ACE-inhibitors and angiotensin-II-receptor antagonists.
Conclusion: Low-dose reserpine-diuretic combinations can be used as first l
ine treatment in patients with mild to moderate arterial hypertension.